Veterinarian Release Form printable pdf download

Veterinarian Release Form

Owners Name____________________________ Phone_________________________

Pets Name____________________ Breed:______________________ Age_________

Veterinarian:____________________________________________________________

Address of Veterinarian:___________________________________________________

Phone: ________________________________________________________________

Known medical conditions:

______________________________________________________________________

During my absence, Pups@Play will be caring for my pet(s). In the event of an

emergency, I authorize Pups@Play to seek medical treatment and will be

responsible for payment for all out of pocket expenses including but not limited to

veterinarian fees, medication, transportation, upon my return.

I, _________________________________, give Pups@Play permission to transport my

pet(s) to my veterinarian and authorize treatment in the event of an emergency or

sickness.

If this veterinarian is not available, I authorize Pups@Play to transport my pet(s) to a

veterinarian of choice and authorize treatment. If emergency care is needed after

regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency

Clinic/Hospital.

I give permission to Pups@Play to approve treatment up to $__________________

(input maximum dollar amount or “no limit”). I agree to be responsible for all charges

upon my return including, but not limited to, vet fees, extra visit fees and transportation

fees.

I agree that Pups@Play is released from all liability related to transportation to and from

veterinarian and treatment for sickness or emergency.

This release will remain valid for all current and future visits unless a new release is

signed.

Clients Signature______________________________________________________

Date ____________________________

Veterinarian Release Form